Despite recent medical advancements, surgery for hilar cholangiocarcinoma is associated with high complication and mortality rates. This may be partly attributed to the absence of established preoperative liver evaluation criteria for safe surgery. This study aimed to propose a reliable indicator for safe and well-planned management of major hepatectomy with extrahepatic bile duct resection.
Methods
We included 150 patients who underwent major hepatectomy with extrahepatic bile duct resection between 2013 and 2021 in Japan. The risk factors for post-hepatectomy liver failure (PHLF) were retrospectively analyzed.
Results
PHLF was observed in 24 (16.0 %) patients who underwent major hepatectomy with extrahepatic bile duct resection. In the multivariate analysis, the identified risk factors for PHLF were the ratio of future remnant liver volume to total liver volume (FRLV/TLV) ≤ 42 % and indocyanine green clearance fraction of the future remnant liver (ICGK-F) ≤ 0.07. Patients with these two factors were significantly associated with PHLF compared with those with either one or none of the risk factors (60.0 % vs 15.1 % and 8.1 %, respectively).
Conclusion
The combinational use of ICGK-F and FRLV/TLV is useful for preoperative liver function assessment with a safety margin to avoid PHLF and postoperative mortality in hepatectomy for hilar cholangiocarcinoma.
{"title":"New criteria for preoperative liver function assessment with safety margins to avoid postoperative mortality during liver resection for hilar cholangiocarcinoma","authors":"Hideaki Kojima , Yuta Abe , Daisuke Udagawa , Koki Hayashi , Naokazu Chiba , Shunichi Imai , Kisyo Mihara , Hisanobu Higashi , Masanori Odaira , Go Oshima , Wataru Koizumi , Minoru Kitago , Hiroshi Yagi , Yasushi Hasegawa , Shutaro Hori , Masayuki Tanaka , Yutaka Nakano , Shigeyuki Kawachi , Yuko Kitagawa","doi":"10.1016/j.hpb.2024.10.013","DOIUrl":"10.1016/j.hpb.2024.10.013","url":null,"abstract":"<div><h3>Background</h3><div>Despite recent medical advancements, surgery for hilar cholangiocarcinoma is associated with high complication and mortality rates. This may be partly attributed to the absence of established preoperative liver evaluation criteria for safe surgery. This study aimed to propose a reliable indicator for safe and well-planned management of major hepatectomy with extrahepatic bile duct resection.</div></div><div><h3>Methods</h3><div>We included 150 patients who underwent major hepatectomy with extrahepatic bile duct resection between 2013 and 2021 in Japan. The risk factors for post-hepatectomy liver failure (PHLF) were retrospectively analyzed.</div></div><div><h3>Results</h3><div>PHLF was observed in 24 (16.0 %) patients who underwent major hepatectomy with extrahepatic bile duct resection. In the multivariate analysis, the identified risk factors for PHLF were the ratio of future remnant liver volume to total liver volume (FRLV/TLV) ≤ 42 % and indocyanine green clearance fraction of the future remnant liver (ICGK-F) ≤ 0.07. Patients with these two factors were significantly associated with PHLF compared with those with either one or none of the risk factors (60.0 % vs 15.1 % and 8.1 %, respectively).</div></div><div><h3>Conclusion</h3><div>The combinational use of ICGK-F and FRLV/TLV is useful for preoperative liver function assessment with a safety margin to avoid PHLF and postoperative mortality in hepatectomy for hilar cholangiocarcinoma.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 159-166"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.hpb.2024.10.018
Eva Philipson , Karolina Jabbar , Svein-Olav Bratlie , Gunnar Hansson , Jan Persson , Caroline Vilhav , Johanna Wennerblom , Riadh Sadik , Peter Naredi , Johan Bourghardt Fagman , Cecilia Engström
Background
Pancreatic cancer has dismal prognosis with a 5-year survival of 12 %. Cystic lesions have been identified as premalignant lesions. The challenge is to identify lesions with high risk of malignant progression, to offer patients prophylactic curative pancreatic surgery. Previous studies have identified mucin biomarker panels (MUCPs) as potential discriminators of pre- and malignant pancreatic cystic lesions. The present study assessed whether MUCPs contribute to more accurate identification of patients with high-risk pancreatic lesions and improve selection for surgery.
Methods
This retrospective crossover study included 88 patients referred to endoscopic ultrasound because of unclear pancreatic cystic lesions. Clinical management and surgical decision-making with and without MUCP values were assessed by two expert teams with access to patient medical history, radiology, fine-needle aspirates, cytology, and cystic fluid carcinoembryonic antigen.
Results
The adjunct of MUCPs improved decision-making in 2 of 21 cases with surgical pathology, identifying one cancer that otherwise would have been missed and sparing one patient from unnecessary surgery.
Conclusion
Access to MUCPs in a clinical setting improved correct selection of high-risk pancreatic lesions for surgery in single cases. A higher number of incorrect recommendations for surgery with the adjunct of MUCPs was also noted, which calls for caution.
{"title":"Adjunct mucin biomarkers MUC2+MUC5AC and MUC5AC+PSCA in a clinical setting identify and may improve correct selection of high-risk pancreatic lesions for surgery","authors":"Eva Philipson , Karolina Jabbar , Svein-Olav Bratlie , Gunnar Hansson , Jan Persson , Caroline Vilhav , Johanna Wennerblom , Riadh Sadik , Peter Naredi , Johan Bourghardt Fagman , Cecilia Engström","doi":"10.1016/j.hpb.2024.10.018","DOIUrl":"10.1016/j.hpb.2024.10.018","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic cancer has dismal prognosis with a 5-year survival of 12 %. Cystic lesions have been identified as premalignant lesions. The challenge is to identify lesions with high risk of malignant progression, to offer patients prophylactic curative pancreatic surgery. Previous studies have identified mucin biomarker panels (MUCPs) as potential discriminators of pre- and malignant pancreatic cystic lesions. The present study assessed whether MUCPs contribute to more accurate identification of patients with high-risk pancreatic lesions and improve selection for surgery.</div></div><div><h3>Methods</h3><div>This retrospective crossover study included 88 patients referred to endoscopic ultrasound because of unclear pancreatic cystic lesions. Clinical management and surgical decision-making with and without MUCP values were assessed by two expert teams with access to patient medical history, radiology, fine-needle aspirates, cytology, and cystic fluid carcinoembryonic antigen.</div></div><div><h3>Results</h3><div>The adjunct of MUCPs improved decision-making in 2 of 21 cases with surgical pathology, identifying one cancer that otherwise would have been missed and sparing one patient from unnecessary surgery.</div></div><div><h3>Conclusion</h3><div>Access to MUCPs in a clinical setting improved correct selection of high-risk pancreatic lesions for surgery in single cases. A higher number of incorrect recommendations for surgery with the adjunct of MUCPs was also noted, which calls for caution.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 214-221"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.hpb.2024.11.003
Leyo Ruo, Pablo E. Serrano, Jennifer Ramsay, James J. Hankinson
{"title":"Transfusion of irradiated autologous blood for hepatobiliary and pancreatic cancer resections: a feasibility study","authors":"Leyo Ruo, Pablo E. Serrano, Jennifer Ramsay, James J. Hankinson","doi":"10.1016/j.hpb.2024.11.003","DOIUrl":"10.1016/j.hpb.2024.11.003","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 260-262"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Consensus on the nomenclature and indications for reoperation for post-operative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) is lacking. This study explores the available literature to classify the different types of reoperations and report outcomes.
Methods
A systematic literature search was performed, including articles from 2010 to 2024 reporting reoperations for POPF after PD. The primary outcome was 30- or 90-day-mortality. Secondary outcomes included reoperation date, additional relaparotomy, ICU-admission, hospital stay, rate of pancreatic-exocrine-insufficiency, diabetes and long-term survivors.
Results
Twenty-five studies were reviewed with 766 patients reoperated for POPF after PD, 283 (37 %) undergoing completion pancreatectomy (CP) and 483 (63 %) pancreas-preserving-procedures (PPPs). Among PPPs, drainage (30 %), wirsungostomy (14 %), pancreatic anastomosis repair (6 %), “sinking” of pancreatic stump (6 %) and re-do pancreatic anastomosis (4 %) were identified. The main indications for reoperation were post-pancreatectomy hemorrhage, necrotizing acute pancreatitis, sepsis and peritonitis. PPPs were preferred with severe hemodynamic instability. Mortality rates after CP and PPPs ranged from 20 to 56 % and 0–67 %, respectively. Early reoperation was associated with reduced ICU-recovery after “sinking” (p = 0.049).
Conclusion
Reoperation for POPF after PD is rarely needed. When it is, early timing seems critical for better outcomes, and PPPs seems to be the best bail out option in patients with severe hemodynamic instability.
{"title":"Reoperation for pancreatic fistula: a systematic review of completion pancreatectomy vs. pancreas-preserving-procedures and outcomes","authors":"Alessio Marchetti , Gaetano Corvino , Giampaolo Perri , Giovani Marchegiani , Raffaele De Luca","doi":"10.1016/j.hpb.2024.11.006","DOIUrl":"10.1016/j.hpb.2024.11.006","url":null,"abstract":"<div><h3>Background</h3><div>Consensus on the nomenclature and indications for reoperation for post-operative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) is lacking. This study explores the available literature to classify the different types of reoperations and report outcomes.</div></div><div><h3>Methods</h3><div>A systematic literature search was performed, including articles from 2010 to 2024 reporting reoperations for POPF after PD. The primary outcome was 30- or 90-day-mortality. Secondary outcomes included reoperation date, additional relaparotomy, ICU-admission, hospital stay, rate of pancreatic-exocrine-insufficiency, diabetes and long-term survivors.</div></div><div><h3>Results</h3><div>Twenty-five studies were reviewed with 766 patients reoperated for POPF after PD, 283 (37 %) undergoing completion pancreatectomy (CP) and 483 (63 %) pancreas-preserving-procedures (PPPs). Among PPPs, drainage (30 %), wirsungostomy (14 %), pancreatic anastomosis repair (6 %), “sinking” of pancreatic stump (6 %) and re-do pancreatic anastomosis (4 %) were identified. The main indications for reoperation were post-pancreatectomy hemorrhage, necrotizing acute pancreatitis, sepsis and peritonitis. PPPs were preferred with severe hemodynamic instability. Mortality rates after CP and PPPs ranged from 20 to 56 % and 0–67 %, respectively. Early reoperation was associated with reduced ICU-recovery after “sinking” (<em>p</em> = 0.049).</div></div><div><h3>Conclusion</h3><div>Reoperation for POPF after PD is rarely needed. When it is, early timing seems critical for better outcomes, and PPPs seems to be the best bail out option in patients with severe hemodynamic instability.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 240-249"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.hpb.2024.10.016
Alessandro M. Bonomi , Anouk G. Overdevest , Jeska A. Fritzsche , Olivier R. Busch , Freek Daams , Geert Kazemier , Rutger-Jan Swijnenburg , Ulrich Beuers , Babs M. Zonderhuis , Roy L.J. van Wanrooij , Joris I. Erdmann , Rogier P. Voermans , Marc G. Besselink
Background
Recurrent non-stenotic cholangitis (NSC) is a challenging and poorly understood complication of a surgical hepaticojejunostomy (HJ). Optimal treatment remains unclear.
Methods
A retrospective single center series including patients with recurrent cholangitis with a non-stenotic HJ after hepato-pancreato-biliary surgery was conducted (2015–2022). Primary outcome was resolution of NSC (i.e. free of NSC during six months). Secondary outcomes included reduction of NSC monthly episode frequency and secondary sclerosing cholangitis.
Results
Overall, 50 of 1179 (4.2%) patients with HJ developed NSC. Treatment included a ‘step-up approach’ with short-course antibiotics (n = 50, 100 %), prolonged antibiotics (n = 26, 52%), and revisional surgery (n = 7, 14 %). Resolution of NSC was achieved in 15 patients (30%) and reduction of NSC frequency in an additional 21 patients (42%). Concomitant ursodeoxycholic acid use and discontinuation of proton pump inhibitors was the only predictor for resolution (OR 4.229, p = 0.035). Secondary sclerosing cholangitis occurred in 12 patients (24%) and was associated with the number of NSC episodes (OR 1.2, p = 0.050).
Conclusion
A ‘step-up approach’ to recurrent NSC after HJ resulted in 30 % resolution and further 42 % reduced frequency of NSC although still a quarter of patients developed secondary sclerosing cholangitis. Future prospective studies should assess whether a protocolized approach could improve outcomes.
{"title":"Outcome of a ‘step-up approach’ for recurrent cholangitis in patients with a non-stenotic hepaticojejunostomy after hepato-pancreato-biliary surgery: single center series","authors":"Alessandro M. Bonomi , Anouk G. Overdevest , Jeska A. Fritzsche , Olivier R. Busch , Freek Daams , Geert Kazemier , Rutger-Jan Swijnenburg , Ulrich Beuers , Babs M. Zonderhuis , Roy L.J. van Wanrooij , Joris I. Erdmann , Rogier P. Voermans , Marc G. Besselink","doi":"10.1016/j.hpb.2024.10.016","DOIUrl":"10.1016/j.hpb.2024.10.016","url":null,"abstract":"<div><h3>Background</h3><div>Recurrent non-stenotic cholangitis (NSC) is a challenging and poorly understood complication of a surgical hepaticojejunostomy (HJ). Optimal treatment remains unclear.</div></div><div><h3>Methods</h3><div>A retrospective single center series including patients with recurrent cholangitis with a non-stenotic HJ after hepato-pancreato-biliary surgery was conducted (2015–2022). Primary outcome was resolution of NSC (i.e. free of NSC during six months). Secondary outcomes included reduction of NSC monthly episode frequency and secondary sclerosing cholangitis.</div></div><div><h3>Results</h3><div>Overall, 50 of 1179 (4.2%) patients with HJ developed NSC. Treatment included a ‘step-up approach’ with short-course antibiotics (n = 50, 100 %), prolonged antibiotics (n = 26, 52%), and revisional surgery (n = 7, 14 %). Resolution of NSC was achieved in 15 patients (30%) and reduction of NSC frequency in an additional 21 patients (42%). Concomitant ursodeoxycholic acid use and discontinuation of proton pump inhibitors was the only predictor for resolution (OR 4.229, p = 0.035). Secondary sclerosing cholangitis occurred in 12 patients (24%) and was associated with the number of NSC episodes (OR 1.2, p = 0.050).</div></div><div><h3>Conclusion</h3><div>A ‘step-up approach’ to recurrent NSC after HJ resulted in 30 % resolution and further 42 % reduced frequency of NSC although still a quarter of patients developed secondary sclerosing cholangitis. Future prospective studies should assess whether a protocolized approach could improve outcomes.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 177-185"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gallbladder cancer is a malignancy with a highly dismal prognosis, requiring optimal surgical strategies to achieve effective outcomes. We aimed to evaluate the outcomes of our algorithm-based decision-making approach based on image T-factors and intraoperative pathology of regional lymph node metastases and the bile duct stumps in patients undergoing gallbladder cancer resection.
Methods
A prospectively maintained database of patients who underwent gallbladder cancer resection between April 2001 and June 2022 was reviewed. Our approach included the decision on the extent of local lymph node dissection based on image T-factors and intraoperative rapid pathological diagnosis. The need for extra bile duct resection was decided according to the intraoperative rapid pathological diagnosis of the cystic or bile duct stump.
Results
Overall, 148 patients underwent gallbladder cancer resection and were assessed to evaluate the efficacy of an institutional algorithm-based surgical strategy. Oncologically acceptable surgery rate was 98.6 and 96.9 % in terms of decision-making on the extents of lymph node dissection and bile duct resection, respectively.
Conclusion
Our step-by-step decision-making approach based on image T-factors and intraoperative pathology for gallbladder cancer resection was effective in achieving oncologically acceptable surgeries.
{"title":"Original articles: step-by-step decision-making for achieving oncologically acceptable but avoiding over-invasive surgery for gallbladder cancer","authors":"Kyoji Ito, Yoshikuni Kawaguchi, Yujiro Nishioka, Akinori Miyata, Akihiko Ichida, Nobuhisa Akamatsu, Norihiro Kokudo, Kiyoshi Hasegawa","doi":"10.1016/j.hpb.2024.10.014","DOIUrl":"10.1016/j.hpb.2024.10.014","url":null,"abstract":"<div><h3>Background</h3><div>Gallbladder cancer is a malignancy with a highly dismal prognosis, requiring optimal surgical strategies to achieve effective outcomes. We aimed to evaluate the outcomes of our algorithm-based decision-making approach based on image T-factors and intraoperative pathology of regional lymph node metastases and the bile duct stumps in patients undergoing gallbladder cancer resection.</div></div><div><h3>Methods</h3><div>A prospectively maintained database of patients who underwent gallbladder cancer resection between April 2001 and June 2022 was reviewed. Our approach included the decision on the extent of local lymph node dissection based on image T-factors and intraoperative rapid pathological diagnosis. The need for extra bile duct resection was decided according to the intraoperative rapid pathological diagnosis of the cystic or bile duct stump.</div></div><div><h3>Results</h3><div>Overall, 148 patients underwent gallbladder cancer resection and were assessed to evaluate the efficacy of an institutional algorithm-based surgical strategy. Oncologically acceptable surgery rate was 98.6 and 96.9 % in terms of decision-making on the extents of lymph node dissection and bile duct resection, respectively.</div></div><div><h3>Conclusion</h3><div>Our step-by-step decision-making approach based on image T-factors and intraoperative pathology for gallbladder cancer resection was effective in achieving oncologically acceptable surgeries.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 186-194"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The risk of mortality due to serious complications associated with hepatectomy for biliary tract cancer remains high. We aimed to investigate the significance of preoperative functional liver volume in predicting and preventing serious morbidity following hepatectomy with bile duct resection (BDR).
Methods
Seventy-one patients who underwent hepatectomy with BDR for biliary tract cancer were included. Functional future remnant liver volume (fFRLV) was calculated using future liver remnant (FLR) volume and functional score measured using EOB-MRI. Patients with unsatisfactory fFRLV values underwent portal or sequential portal/hepatic vein embolization (PVE/HVE). We assessed relationship between variables for liver-related morbidity (LRM), including posthepatectomy liver failure, bile leakage, and persistent ascites. Additionally, we assessed Clavien-Dindo grade IV complications (CD ≥ IV) as indicators of serious morbidity.
Results
LRM and CD ≥ IV occurred in 20 (28.2 %) and 6 (8.5 %) cases, respectively. Preoperative FLR volume (p = 0.021), FLR ratio (p = 0.004), fFRLV (p = 0.008), and ICGK-F (p = 0.023) were associated with LRM. fFRLV (p = 0.017) was predictive for LRM but not independent (AUC:0.704). Preoperative FLR volume (p = 0.005), FLR ratio (p = 0.008), and fFRLV (p < 0.001) were associated with CD ≥ IV. fFRLV (p = 0.017) was an independent predictive factor for CD ≥ IV(AUC:0.914), showing greater predictive power compared to other factors.
Conclusion
fFRLV predicts CD ≥ IV in patients undergoing hepatectomy with BDR. A sufficient fFRLV, enhanced by PVE/HVE if necessary, may prevent serious morbidity and mortality.
{"title":"Preoperative setting of functional liver volume enhanced by portal and hepatic vein embolization is key in preventing serious morbidity after hepatectomy with bile duct resection for biliary tract cancer","authors":"Kenichiro Araki, Akira Watanabe, Takamichi Igarashi, Mariko Tsukagoshi, Norihiro Ishii, Shunsuke Kawai, Kei Hagiwara, Kouki Hoshino, Takaomi Seki, Norifumi Harimoto, Ken Shirabe","doi":"10.1016/j.hpb.2024.11.005","DOIUrl":"10.1016/j.hpb.2024.11.005","url":null,"abstract":"<div><h3>Background</h3><div>The risk of mortality due to serious complications associated with hepatectomy for biliary tract cancer remains high. We aimed to investigate the significance of preoperative functional liver volume in predicting and preventing serious morbidity following hepatectomy with bile duct resection (BDR).</div></div><div><h3>Methods</h3><div>Seventy-one patients who underwent hepatectomy with BDR for biliary tract cancer were included. Functional future remnant liver volume (fFRLV) was calculated using future liver remnant (FLR) volume and functional score measured using EOB-MRI. Patients with unsatisfactory fFRLV values underwent portal or sequential portal/hepatic vein embolization (PVE/HVE). We assessed relationship between variables for liver-related morbidity (LRM), including posthepatectomy liver failure, bile leakage, and persistent ascites. Additionally, we assessed Clavien-Dindo grade IV complications (CD ≥ IV) as indicators of serious morbidity.</div></div><div><h3>Results</h3><div>LRM and CD ≥ IV occurred in 20 (28.2 %) and 6 (8.5 %) cases, respectively. Preoperative FLR volume (p = 0.021), FLR ratio (p = 0.004), fFRLV (p = 0.008), and ICGK-F (p = 0.023) were associated with LRM. fFRLV (p = 0.017) was predictive for LRM but not independent (AUC:0.704). Preoperative FLR volume (p = 0.005), FLR ratio (p = 0.008), and fFRLV (p < 0.001) were associated with CD ≥ IV. fFRLV (p = 0.017) was an independent predictive factor for CD ≥ IV(AUC:0.914), showing greater predictive power compared to other factors.</div></div><div><h3>Conclusion</h3><div>fFRLV predicts CD ≥ IV in patients undergoing hepatectomy with BDR. A sufficient fFRLV, enhanced by PVE/HVE if necessary, may prevent serious morbidity and mortality.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 167-176"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-31DOI: 10.1016/j.hpb.2025.01.015
Nazgol K Shahbaz, Kevin Verhoeff, Tyrell Wees, Sukhdeep Jatana, Douglas Quan, Juan Glinka, Anton Skaro, Ephraim S Tang
Background: The benefits of MIS in older adults are conflicting. This study evaluates demographics and early outcomes, for older patients (≥75) undergoing minimally invasive (MIS) versus open pancreaticoduodenectomy (PD).
Method: We categorized elderly patients who underwent PD from 2017 to 2021 NSQIP databases by surgical approach (open vs MIS). Baseline characteristics were examined with bivariate analysis, and multivariate logistic regression assessed the independent effect of minimally invasive surgery on 30-day serious complications and mortality.
Results: Amongst 4137 patients, 150 (3.63 %) underwent MIS PD. Patients demographics were similar. Open cohorts were older (79.1 vs 78.4 years; p = 0.011) with greater tumor invasion (36.6 % vs. 27.0 %; p = 0.018). MIS had longer operations (133.1 vs 119.6 min; p < 0.001). Multivariate analysis demonstrated that MIS approach was associated with increased serious complications (OR 2.21; p < 0.001), but not mortality (OR 2.11; p = 0.173). Post hoc analysis excluding cases converted to open demonstrated no difference in serious complications (OR 1.94; p = 0.070) or mortality (OR 3.58; p = 0.094). PSM analysis estimated a 14.7 % higher rate of serious complications in MIS but similar mortality (p = 0.291).
Conclusions: MIS PD uptake in elderly patients remains limited, with early findings indicating longer operations and higher complications. Further research on patient selection differences, technique modifications, and center expertise is required.
{"title":"Laparoscopic versus open pancreaticoduodenectomy outcomes in patients ≥ 75 years old: an NSQIP analysis of 4343 patients.","authors":"Nazgol K Shahbaz, Kevin Verhoeff, Tyrell Wees, Sukhdeep Jatana, Douglas Quan, Juan Glinka, Anton Skaro, Ephraim S Tang","doi":"10.1016/j.hpb.2025.01.015","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.015","url":null,"abstract":"<p><strong>Background: </strong>The benefits of MIS in older adults are conflicting. This study evaluates demographics and early outcomes, for older patients (≥75) undergoing minimally invasive (MIS) versus open pancreaticoduodenectomy (PD).</p><p><strong>Method: </strong>We categorized elderly patients who underwent PD from 2017 to 2021 NSQIP databases by surgical approach (open vs MIS). Baseline characteristics were examined with bivariate analysis, and multivariate logistic regression assessed the independent effect of minimally invasive surgery on 30-day serious complications and mortality.</p><p><strong>Results: </strong>Amongst 4137 patients, 150 (3.63 %) underwent MIS PD. Patients demographics were similar. Open cohorts were older (79.1 vs 78.4 years; p = 0.011) with greater tumor invasion (36.6 % vs. 27.0 %; p = 0.018). MIS had longer operations (133.1 vs 119.6 min; p < 0.001). Multivariate analysis demonstrated that MIS approach was associated with increased serious complications (OR 2.21; p < 0.001), but not mortality (OR 2.11; p = 0.173). Post hoc analysis excluding cases converted to open demonstrated no difference in serious complications (OR 1.94; p = 0.070) or mortality (OR 3.58; p = 0.094). PSM analysis estimated a 14.7 % higher rate of serious complications in MIS but similar mortality (p = 0.291).</p><p><strong>Conclusions: </strong>MIS PD uptake in elderly patients remains limited, with early findings indicating longer operations and higher complications. Further research on patient selection differences, technique modifications, and center expertise is required.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-31DOI: 10.1016/j.hpb.2025.01.014
Sarah B Hays, Kristine Kuchta, Aram E Rojas, Syed A Mehdi, Jason L Schwarz, Mark S Talamonti, Melissa E Hogg
Introduction: Virtual reality has been shown to be a strong introduction to the robot. However, we hypothesized that a biotissue curriculum including common surgical anastomoses can further enhance robotic technical skills in surgical residents.
Methods: Post-graduate-year three (PGY-3) general surgery residents completed a two-week robotic simulation rotation. The inanimate exercises used biotissue to simulate common robotic anastomoses, including the running hepaticojejunostomy (RHJ), gastrojejunostomy (GJ), interrupted hepaticojejunostomy (IHJ), and pancreaticojejunostomy (PJ). Drills were timed and graded according to modified Objective Structured Assessment of Technical Skills (OSATS; range 6-30).
Results: 32 residents completed the curriculum. 81.3% of residents reported prior experience at the surgeon console (median=5 operations). Across all drills the average time to completion decreased from first to fourth attempt (RHJ: 33.7±8.9 vs. 26.3±8.1 min, p<0.001; GJ: 57.2±15.1 vs. 44.6±9.5 min, p<0.001; IHJ: 32.6±7.2 vs. 27.1±7.7 min, p<0.001; PJ: 44.2±9.3 vs. 35.6±10.5 min, p<0.001). Average OSATS score increased across all drills as well (RHJ: 16.0±3.8 vs. 23.3±3.4, p<0.001; GJ: 19.4±2.1 vs. 26.0±2.5, p<0.001; IHJ: 16.9±2.7 vs. 23.2±3.6, p<0.001, PJ: 17.9±2.6 vs. 23.6±3.6, p<0.001).
Conclusion: The robotic biotissue curriculum improves resident performance on robotic anastomoses. With the rise of the robotic platform, training in robotic procedures should be incorporated during surgical residency.
{"title":"Residency robotic biotissue curriculum: the next frontier in robotic surgical training.","authors":"Sarah B Hays, Kristine Kuchta, Aram E Rojas, Syed A Mehdi, Jason L Schwarz, Mark S Talamonti, Melissa E Hogg","doi":"10.1016/j.hpb.2025.01.014","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.014","url":null,"abstract":"<p><strong>Introduction: </strong>Virtual reality has been shown to be a strong introduction to the robot. However, we hypothesized that a biotissue curriculum including common surgical anastomoses can further enhance robotic technical skills in surgical residents.</p><p><strong>Methods: </strong>Post-graduate-year three (PGY-3) general surgery residents completed a two-week robotic simulation rotation. The inanimate exercises used biotissue to simulate common robotic anastomoses, including the running hepaticojejunostomy (RHJ), gastrojejunostomy (GJ), interrupted hepaticojejunostomy (IHJ), and pancreaticojejunostomy (PJ). Drills were timed and graded according to modified Objective Structured Assessment of Technical Skills (OSATS; range 6-30).</p><p><strong>Results: </strong>32 residents completed the curriculum. 81.3% of residents reported prior experience at the surgeon console (median=5 operations). Across all drills the average time to completion decreased from first to fourth attempt (RHJ: 33.7±8.9 vs. 26.3±8.1 min, p<0.001; GJ: 57.2±15.1 vs. 44.6±9.5 min, p<0.001; IHJ: 32.6±7.2 vs. 27.1±7.7 min, p<0.001; PJ: 44.2±9.3 vs. 35.6±10.5 min, p<0.001). Average OSATS score increased across all drills as well (RHJ: 16.0±3.8 vs. 23.3±3.4, p<0.001; GJ: 19.4±2.1 vs. 26.0±2.5, p<0.001; IHJ: 16.9±2.7 vs. 23.2±3.6, p<0.001, PJ: 17.9±2.6 vs. 23.6±3.6, p<0.001).</p><p><strong>Conclusion: </strong>The robotic biotissue curriculum improves resident performance on robotic anastomoses. With the rise of the robotic platform, training in robotic procedures should be incorporated during surgical residency.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-31DOI: 10.1016/j.hpb.2025.01.011
Mikolaj R Kowal, Varuni Bhatnagar, James Pine, Samir Pathak, Andrew Smith, Iestyn Shapey
Aims: Severe acute pancreatitis (SAP) remains a lethal condition with a rising incidence worldwide. Recent randomised trials suggest that peritoneal lavage and/or dialysis (PLD), when administered early in SAP, may be beneficial to improve patient outcomes. This study aimed to review this data systematically.
Methods: Studies featuring PLD for the treatment of SAP were searched systematically (2012 Atlanta classification to 2023). A traditional approach to reporting data was augmented by a narrative synthesis.
Results: 210 articles were reviewed, of which six studies featuring 499 patients were included. The technical approach, duration and type of lavage varied in each study and no safety concerns were reported. In patients undergoing PLD, improvements in inflammatory markers and length of stay were seen in all studies. Where reported, fewer invasive procedures for peri-pancreatic fluid collections were required after PLD. Lower mortality was seen in cohorts receiving laparoscopic lavage alone and combined lavage and dialysis when compared with standard treatment. All studies were rated at moderate or high risk of bias.
Conclusions: PLD demonstrates potential as an early therapy to improve outcomes for patients with SAP. Further research is required to define intervention delivery, explore acceptability and investigate efficacy through a powered randomised controlled trial.
{"title":"Systematic review of peritoneal lavage and dialysis for patients with severe acute pancreatitis.","authors":"Mikolaj R Kowal, Varuni Bhatnagar, James Pine, Samir Pathak, Andrew Smith, Iestyn Shapey","doi":"10.1016/j.hpb.2025.01.011","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.011","url":null,"abstract":"<p><strong>Aims: </strong>Severe acute pancreatitis (SAP) remains a lethal condition with a rising incidence worldwide. Recent randomised trials suggest that peritoneal lavage and/or dialysis (PLD), when administered early in SAP, may be beneficial to improve patient outcomes. This study aimed to review this data systematically.</p><p><strong>Methods: </strong>Studies featuring PLD for the treatment of SAP were searched systematically (2012 Atlanta classification to 2023). A traditional approach to reporting data was augmented by a narrative synthesis.</p><p><strong>Results: </strong>210 articles were reviewed, of which six studies featuring 499 patients were included. The technical approach, duration and type of lavage varied in each study and no safety concerns were reported. In patients undergoing PLD, improvements in inflammatory markers and length of stay were seen in all studies. Where reported, fewer invasive procedures for peri-pancreatic fluid collections were required after PLD. Lower mortality was seen in cohorts receiving laparoscopic lavage alone and combined lavage and dialysis when compared with standard treatment. All studies were rated at moderate or high risk of bias.</p><p><strong>Conclusions: </strong>PLD demonstrates potential as an early therapy to improve outcomes for patients with SAP. Further research is required to define intervention delivery, explore acceptability and investigate efficacy through a powered randomised controlled trial.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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